Study finds fourfold range in rates of mental health problems among children based on relational, social risks

Baltimore (Maryland) [US], January 26 : A child's upbringing and the environment of upbringing plays a major role in the child's self-confidence and resilience.
A new study, published online in 'Child and Adolescent Psychiatric Clinics of North America', led by researchers at Johns Hopkins Bloomberg School of Public Health, found that children who were facing relational risks only, such as substance abuse among family members, were more likely to have mental, emotional, or behavioural concerns than those who were only facing social risks, such as economic hardship.
The large multi-year study, based on 2016-2019 data, found that children facing relational and social risks were more likely to have mental, emotional, or behavioural health problems, but the negative impact of these problems on child resilience, self-regulation and school engagement could be offset by protective factors such as strong caretaker-child connection and family resilience.
The findings were published as the U.S. and other countries are facing a crisis in children's mental health exacerbated by the pandemic.
The study found that, overall, 21.8 per cent of U.S. children aged 3 to 17 had one or more of the common mental, emotional, and behavioural health conditions assessed. The prevalence of mental health problems across U.S. children ranged from about 15 to 60 per cent, increasing with the type (social, relational, or both) and a number of these risks that children had been exposed to.
The analysis, based on survey responses covering nearly 132,000 children aged 3 to 17, examined the complex interplay between common mental health problems among children, social and relational health risks, and protective factors.
"If we treat children with mental, emotional, and behavioural problems without individually and collectively addressing social and relational health risks, or even assessing them, which is often the case, we are missing some of the biggest factors driving the mental and emotional suffering of our children," said study leader Christina Bethell, PhD, MPH, MBA, professor in the Department of Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative at the Bloomberg School.
Research suggested that both social and relational health risks contributed to mental, emotional, and behavioural health problems in children. Much prior research had focused on individual social and relational health risks. The new study investigated both the individual and combined effects of these factors on U.S. children.
For their analysis, Bethell and her colleagues gathered data from the National Survey of Children's Health, an annual survey led by the U.S. Health Resources and Services Administration's Maternal and Child Health Bureau in collaboration with the U.S. Bureau of the Census. The survey, administered to thousands of parents and caregivers each year, provided data on multiple, intersecting aspects of children's lives -- including physical and mental health, access to quality health care, and the child's family, neighbourhood, school, and social context.
The study found that over two-thirds of children with mental health conditions experienced at least one of the eight evidence-based social or relational health risk factors examined in the analysis compared to about half of children without mental health conditions.
Factors examined included economic hardship, food insecurity, unsafe neighbourhood, racial discrimination, multiple Adverse Childhood Experiences (ACEs) like substance abuse or domestic violence, poor caregiver mental health, and low levels of caregiver coping or high aggravation with their child.
Relational versus social health risks were both more prevalent among children with mental health problems and had a stronger association with these conditions. Nearly one-third of children with mental health problems experienced both types of risks.
A key focus of the study was on identifying opportunities to promote positive outcomes among children with mental, emotional, and behavioural conditions who also experience social and relational health risks, with a focus on their engagement in school and building their own resilience, assessed as the ability to regulate emotions and behaviour when facing challenges.
Researchers found that the chances a child was engaged in school were 77 per cent less if they lacked self-regulation. Offering hope, the chances a child with mental health problems demonstrated good self-regulation -- a key component of resilience -- were 5.73 times greater when children also experienced stronger parent-child connection. These odds were over 2.25 times greater when their family reported staying hopeful and could identify strengths to draw on during difficult times. Findings were consistent across all levels of social and relational health risks.
Bethell noted that both parent-child connection and family resilience were learned behaviours that could be strengthened through supports to families and skills building. Bethell noted that the American Academy of Pediatrics recommended promoting these factors during routine well-child check-ups, through schools, in mental health treatment, and in the community at large.
"There is a mental, emotional, and behavioural health crisis for children in our country, but most children with these conditions have risk factors that we can identify and do something about," said study co-author Tamar Mendelson, PhD, MA, a Bloomberg Professor of American Health in the Bloomberg School's Department of Mental Health. "Ultimately, we need to address the structural and systemic issues that threaten young people's well-being; at the same time, there is a lot we can be doing to decrease risk factors for families."